神经modulation for the treatment of medication-refractory epilepsy

118金宝搏抽水宾夕法尼亚州健康神经外科是手术治疗的医学抗癫痫的最前沿。尽管癫痫在大约三分之二的患者中受到医学控制，但药物难治性癫痫病无法治疗这种病情，但长期治疗的必要条件是需要手术选择。

“Neurostimulation devices improve outcomes through seizure control where seizures become less frequent and severe,” said Dr. Michael D. Sather, surgical director of the Comprehensive Epilepsy Center atPenn State Health Milton S. Hershey Medical Centerand associate professor of neurosurgery in theDepartment of Neurosurgery在Penn State College of Medicine. “The devices use electrical stimulation to modify the brain networks to reduce seizure occurrence, which improves the patient’s quality of life.”

Forms of neuromodulation

All three primary forms of neuromodulation are offered to patients with epilepsy at Penn State Health:

• 反应性神经刺激（RNS）
• 迷走神经刺激（VNS）
• Deep brain stimulation (DBS)

每个神经调节设备都有一个由两部分组成的系统，包括用于电信号的发电机以及将发电机刺激到神经目标的设备的一部分。

RNS方法是一种基于目标的治疗，取决于在患者大脑中定位癫痫发作的来源。这种闭环刺激形式最适合癫痫发作的情况，但是大脑的区域不能安全或没有神经系统缺陷。

VNS and DBS are agnostic devices that do not rely on determining the location of seizures in the brain.

VNS方法使用颈部迷走神经作为向大脑刺激的途径。这是神经调节的侵入性最低，也是抗脑部手术并发症的高风险或高风险患者的理想选择。

“VNS treatment is common for patients with moderate to severe developmental delays, including cerebral palsy or developmental abnormalities in the brain,” Sather said. “For these patients, brain surgery is used less commonly, but they often do really well with VNS. With a significant seizure reduction, we’re able to improve mood and alertness with quality of life and reduced medication.”

DBS方法通过大脑中的嵌入电极提供持续的刺激。DBS在2018年获得了FDA认证，是癫痫患者的最新神经调节方法。萨瑟（Sather）表示，由于冠状病毒大流行带来的批准和破坏，该程序正处于“升级”阶段，实践量继续增长。

神经调节的阳性结果

当VN出现时，这是无法接受其他形式癫痫手术的患者的唯一选择。

“Today, treatment outcomes have improved further since we’re able to utilize several neuromodulation devices in the practice,” Sather said. “It’s not a contraindication to place another neuromodulation device or remove one and place another when it’s indicated for seizure control.”

While initial treatment plans rarely involve the use of more than one device, having one device is not equivalent to having another. Having multiple neuromodulation devices available to choose from gives neurologists more treatment possibilities.

深脑刺激的数据表明，无论患者先前的治疗或癫痫手术如何，癫痫发作率都保持不变。萨瑟报告在七年内癫痫发作约为75％，无论患者是否接受过神经调节或改良手术。

迷走神经刺激法程序,萨瑟了60%到70% seizure reduction. The RNS procedure also provides dramatic reductions over time, with data reporting 75% to 80% seizure reduction three to seven years post-treatment.

After more than a decade of RNS in epilepsy practice, experts have seen accelerated seizure reduction through the physician’s learning curve. Sather reports that at Penn State Health, one-third of patients are “high responders,” with a seizure reduction of 90%.

“Sometimes patients have seizures coming from the temporal lobe that is dominant for memory, yet have little memory deficits. In the past, we didn’t have good options for this group of patients,” Sather said. “Now we can put electrodes in the hippocampus or temporal lobe and treat epilepsy without adversely affecting their memory.”

在宾夕法尼亚州健康中接受癫痫治疗的患者由大约70％的成年人和30％的儿童组成，包括转诊118金宝搏抽水和直接治疗。

118金宝搏抽水宾夕法尼亚州健康对癫痫治疗的一流排名

Penn State Health’s Comprehensive Epilepsy Center isLevel 4 certified by the National Association of Epilepsy Centers（NAEC），NAEC将其描述为一个中心，提供更复杂的密集神经诊断监测，以及更广泛的医学，神经心理学和社会心理治疗。

The epilepsy experts at Penn State Health also perform the highest quality neuroimaging, including MRI and functioning MRI scans. Neuroradiologists use these advanced MRIs to locate small lesions or undifferentiated lesions on the brain. In addition, the Epilepsy Center offers video EEG, which allows providers toobserve seizures when they occur and to determine the frequency and location癫痫发作。这为萨瑟（Sather）和受过奖学金培训的神经科医生提供了几种诊断和治疗方法。

癫痫治疗团队每月两次召集患者管理会议，讨论他们患者的癫痫旅程，历史和频率以及他们所经历的癫痫发作的类型，并审查其视频脑电图。这些会议有助于团队决定是继续诊断还是提供治疗，这对于在宾夕法尼亚州健康的患者来说是一个独特的好处。118金宝搏抽水

萨瑟说：“我们的神经科医生是接受癫痫的培训的研究金。”“他们专门治疗癫痫病，不练习一般的神经病学，使他们在这一领域成为专家。”